The effect of computerized cognitive training and transcranial direct current stimulation on working memory among post-stroke individuals: a systematic review with meta-analysis and meta-regression.

BACKGROUND: Working memory (WM) impairment is a common phenomenon after stroke; however, its management in rehabilitation is less researched. This systematic review and meta-analysis aimed to provide a quantitative synthesis of the impact of computerised cognitive training (CCT) and transcranial direct current stimulation (tDCS) on WM span in post-stroke individuals. METHODS: The literature search in PubMed, Embase, Scopus, and Cochrane Library focused on randomized controlled trials testing the effect of CCT and tDCS on treated stroke patients as compared to untreated controls. Neuropsychological instruments such as Digit Span Forward/Backward and Visual Span Forward Tests defined the outcome of WM span. After extracting study characteristics and quality assessment using the Cochrane Risk of Bias Tool, we conducted a meta-analysis and meta-regression using standardised mean differences. RESULTS: The search yielded 4142 articles, nine of which (N = 461) fulfilled the inclusion criteria. In the case of CCT, we found significant improvement in Digit Span Backward Test (Z = 2.65, P = 0.008; 95% CI [0.10, 0.67]) and Visual Span Forward Test performance (Z = 3.05, P = 0.002; 95% CI [0.15, 0.69]), while for tDCS, we could not find a sufficient number of studies for the analysis. Furthermore, no significant moderating factor was found in the meta-regression. CONCLUSIONS: In conclusion, CCT appears to be a suitable choice to enhance WM span performance after stroke. However, further research is needed to investigate the effect of tDCS due to the limited number of studies. TRIAL REGISTRATION: The meta-analysis was conducted according to PRISMA (Preferred Reporting of Systematic Reviews and Meta-Analyses) standards with a PROSPERO registration protocol (ID: CRD42023387182).

The clinical effectiveness of the Mind/Body Program for Infertility on wellbeing and assisted reproduction outcomes: a randomized controlled trial in search for active ingredients.

STUDY QUESTION: Does the Mind/Body Program for Infertility (MBPI) perform better, due to certain distinctive elements, than a partly matched support group in improving the wellbeing and medically assisted reproduction (MAR) outcomes of women with elevated distress levels in a clinical setting? SUMMARY ANSWER: While robust enhancements occurred in the wellbeing overall, the cognitive behavioural and formalized stress management elements of the MBPI allowed a significantly stronger improvement in trait anxiety, but not in other mental health and MAR outcomes, compared with a support group. WHAT IS KNOWN ALREADY: Mind-body psychological programmes adjacent to MAR have been found to improve women's mental states and possibly increase chances of pregnancy. However, not enough is known about the programme's effectiveness among patients with elevated distress levels in routine clinical settings, nor is it clear which of its particular ingredients are specifically effective. STUDY DESIGN, SIZE, DURATION: A pre-post design, single-centre, randomized controlled trial was performed between December 2019 and October 2022 (start and end of recruitment, respectively). The sample size (n = 168) was calculated to detect superiority of the MBPI in improving fertility-related quality of life. Randomization was computer-based, with random numbers concealing identities of patients until after allocation. PARTICIPANTS/MATERIALS, SETTING, METHODS: The trial was conducted at a large university teaching hospital. A total of 168 patients were randomly assigned to the mind-body (MBPI) group (n = 84) and the fertility support (FS) control group (n = 84). Patients received a 10-week, 135-min/week group intervention, with the FS group following the same format as the MBPI group, but with a less restricted and systematic content, and without the presumed effective factors. The number of patients analysed was n = 74 (MBPI) and n = 68 (FS) for post-intervention psychological outcomes, and n = 54 (MBPI) and n = 56 (FS) for pregnancy outcomes at a 30-month follow-up. MAIN RESULTS AND THE ROLE OF CHANCE: Significant improvements occurred in both groups in all psychological domains (adjusted P < 0.001), except for treatment-related quality of life. Linear mixed-model regression analysis did not reveal significantly greater pre-post improvements in the MBPI group than in the FS group in fertility-related quality of life (difference in differences (DD) = 4.11 [0.42, 7.80], d = 0.32, adjusted P = 0.124), treatment-related quality of life (DD = -3.08 [-7.72, 1.55], d = -0.20, adjusted P = 0.582), infertility-specific stress (DD = -2.54 [-4.68, 0.41], d = -0.36, adjusted P = 0.105), depression (DD = -1.16 [3.61, 1.29], d = -0.13, adjusted P = 0.708), and general stress (DD = -0.62 [-1.91, 0.68], d = -0.13, adjusted P = 0.708), but it did show a significantly larger improvement in trait anxiety (DD = -3.60 [-6.16, -1.04], d = -0.32, adjusted P = 0.042). Logistic regression showed no group effect on MAR pregnancies, spontaneous pregnancies, or live births. LIMITATIONS, REASONS FOR CAUTION: The follow-up only covered MAR-related medical outcomes and no psychological variables, and their rates were not equal in the two groups. Biological factors other than age, aetiology, and duration of infertility may have confounded the study results. Loss to follow-up was between 5% and 10%, which may have led to some bias. WIDER IMPLICATIONS OF THE FINDINGS: The psychologically and medically heterogeneous sample, the normal clinical setting and the low attrition rate all raise the external validity and generalizability of our study. The MBPI works not only in controlled conditions, but also in routine MAR practice, where it can be introduced as a cost-effective, low-intensity psychological intervention, within the framework of stepped care. More studies are needed to further identify its active ingredients. STUDY FUNDING/COMPETING INTEREST(S): The authors received no financial support for the research, authorship, and/or publication of this article. The authors have no conflict of interest to disclose. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04151485. TRIAL REGISTRATION DATE: 5 November 2019. DATE OF FIRST PATIENT'S ENROLMENT: 15 December 2019.

The SCREENIVF Hungarian version is a valid and reliable measure accurately predicting possible depression in female infertility patients.

Infertility patients, often in high distress, are entitled to being informed about their mental status compared to normative data. The objective of this study was to revalidate and test the accuracy of the SCREENIVF, a self-reported tool for screening psychological maladjustment in the assisted reproduction context. A cross-sectional, questionnaire-based online survey was carried out between December 2019 and February 2023 in a consecutive sample of female patients (N = 645, response rate 22.9%) in a university-based assisted reproduction center in Hungary. Confirmatory factor analysis and cluster and ROC analyses were applied to test validity, sensitivity and specificity in relation to Beck Depression Inventory (BDI) scores. Model fit was optimal (chi-square = 630.866, p < 0.001; comparative fit index = 0.99; root-mean-square error of approximation = 0.018 (90% CI 0.013-0.023); standardized-root-mean-square-residual = 0.044), and all dimensions were reliable (α > 0.80). A specific combination of cutoffs correctly predicted 87.4% of BDI-scores possibly indicative of moderate-to-severe depression (χ2(1) = 220.608, p < 0.001, Nagelkerke R2 = 0.462, J = 66.4). The Hungarian version of the SCREENIVF is a valid and reliable tool, with high accuracy in predicting BDI-scores. Low response rate may affect generalizability. The same instrument with different cutoffs can serve various clinical goals.

A simplified measure of burnout symptoms among paramedics - an exploratory analysis of a Hungarian sample.

BACKGROUND: Burnout is still one of the leading mental health problems. According to research results over the past decades, healthcare workers, including paramedics, are considered a high-risk group. In concordance with these results, the available resources need to prioritize monitoring paramedics' mental health. METHODS: In our study, we investigated whether the available test batteries measuring burnout could be reduced while maintaining their effectiveness. We reduced the 21-item Burnout Measurement and the 8-item version of the Psychosomatic Symptom Scale using the data of 727 Hungarian paramedics. We selected the top four items of the questionnaires that were significantly correlated with the original Burnout Measure Index and the Psychosomatic Scale Index. The classification efficiency of the shortened list of items was based on the initial risk categories of the Burnout Measure and its sensitivity was analyzed using Binary Logistic regression and ROC curves. We then used Two-Step Cluster Analysis to test the ability of the shortened Burnout Measure Index to develop new risk categories. The reliability indicators were also explored. RESULTS: The results show that the Burnout Measurement can be reduced to 4 items with a classification efficiency of 93.5% in determining the level of burnout. The 5-item reduction of the Psychosomatic Symptom Scale can classify subjects to the appropriate intervention level for burnout with an efficiency of 81.6%. The ROC analysis suggests that the shortened questionnaires have an excellent separative ability to discriminate between the initial risk groups. Three new risk categories were also identified as a result of the cluster analysis. CONCLUSION: The shortened scales may be proven effective in resource management, which could significantly quicken the assessment of burnout in the future. The abbreviated scale is also suitable for classifying subjects into risk categories. However, further research is needed to see whether the shortened scales can be used as a diagnostic tool.

Voxel-based asymmetry of the regional gray matter over the inferior temporal gyrus correlates with depressive symptoms in medicated patients with major depressive disorder.

The number of patients suffering from major depressive disorder (MDD) is increasing worldwide. Imbalanced hemispherical brain activity may be an underlying factor of MDD; however, whether structural asymmetry also contributes to the symptoms experienced in MDD has been scarcely investigated. In this study, we aimed to examine cortical asymmetry in association with the severity of depressive and cognitive symptoms observed in MDD during stable medication. The association between the affective and cognitive symptoms and gray matter asymmetry was evaluated in 17 MDD patients using voxel-wise gray matter asymmetry analysis on high-resolution T1-weighted MR images. Asymmetry index values in the inferior temporal gyrus (ITG) correlated with the scores of the 17-item Hamilton Depression Rating Scale (HDRS), but no association was found with the Beck Hopelessness Scale, and performance on the 1-, 2- and 3-back task. Our results indicate that the asymmetry of gray matter content in the ITG might be associated with higher depression severity. Our findings might help to better understand how structural changes contribute to depression severity in patients with MDD.

Clustering Infertile Couples With Dyadic Approach: WHO-5-WBI as a Promising Tool for Assessing Psychological State.

Infertility may be associated with severe psychological burden and many couples need mental support. We used dyadic approach to identify couples with disturbed psychological condition and we tested the WHO-5 Well-Being Index (WHO-5-WBI) questionnaire as a possible, rapid screening method. Extensive psychological assessment of infertile couples was carried out with Beck's Depression Inventory, Spielberger State-Trait Anxiety Inventory, WHO-5-WBI, Symptom Check List-90 Revised Test, Fagerstrom Test for Nicotine Dependence, Alcohol Use Disorders Identification Test. Data of 128 patients (64 couples) were used in the statistical calculations. The Two-Step cluster analysis has revealed 2 groups, which could be separated supremely based on the level of experienced depression, anxiety and according to the general mental health. The WHO-5-WBI questionnaire showed consistent results while classifying couples into groups, which were formed. Our results indicate that infertility affects both spouses almost in the same extent in several psychological aspects. A cluster of couples with increased psychological burden could be clearly separated. The WHO-5-WBI questionnaire was a promising tool to screen reliably spouses based on their psychological state and identify couples that need psychological support during their fertility work-up and treatment.